Conclusion:The physiological immune response to exercise is diminished in CHF patients who also exhibit significant catabolic/anabolic imbalance. This finding supports the concept that CHF presents a complex clinical syndrome with alterations in metabolic and immunological pathways and that a reduced exercise capacity may be caused also by more peripherally rather than central, cardiac abnormalities. P106/9931Skeletal muscle atrophy and decreased muscle strength correlate with cytokine activation in chronic heart failure P.C. Schulze, S. MWius-Winkler, A. Linke, V. Adams, N. Schoene, S. Erbs, S. Gielen, M. Bus&, G. Schuler, R. Hambrecht. University of Leipzig, Heart Center, Department of Cardiology; ' University of Leipzig, Faculty of Sports, Department of Sports Medicine; Leipzig, GermanyPatients (pts) with chronic heart failure (CHF) show a progressive exercise intolerance and early muscle fatigue. Recently, activation of proinflammatory cytokines has been described in CHF. Animal studies showed muscle atrophy and a decreased in vitro muscle contractility under the influence of TNFcu. The aim of this study was to assess the relation between serum TNFa levels, muscle cross-sectional area (CSA) and muscle function of the thigh in pts with CHF and healthy controls. The study group consisted of 10 non-cachectic CHF pts and 8 agematched healthy controls (LVEF 23 f 2 vs. 69.7 * I%, BMI 26.9 f 0.6 vs. 28.8 f 1.0 kg/m*). Cross-sectional area (CSA) of the thigh was assessed by computerized tomography. Under electromyographical control, maximal quadriceps muscle strength and the relative decrease of muscle strength over a period of 20 s was measured. Serum-TNFcu was detected by immunoassay.Pts with CHF had elevated serum TNFu levels (2.84 f 0.37 pg/ml vs. 1.4 + 0.32 pg/ml, p < 0.01) and a reduced muscle CSA (139.3 f 9.7 cm* vs. 172.0 f 5.5 cm*, p < 0.01) as compared to healthy controls. Maximal quadriceps muscle strength did not significantly differ between the groups (236.9 f 30.9 N vs. 283.4 f 31.0 N). The decrease of maximal muscle strength as a parameter of fatiguebility was significantly higher in the CHF group (-0.115 f 0.025 N/s vs. -0.032 f 0.015 N/s, p < 0.01). Higher serum levels of TNFa correlated with a reduced muscle CSA (r = -0.48, p < 0.05). A faster decrease of muscle strenght correlated with both, a lower CSA (r = 0.5, p < 0.05) and higher serum levels of TNFar (r = -0.51, p < 0.05).Our data suggest that higher TNFor serum levels might contribute to a loss of muscle bulk and an impairment of muscle contractility in noncachectic patients with CHF. This could be a possible mechanism related to exercise intolerance and early muscle fatiguebility in CHF. P107/10164The early rehabilitation of patients with decompensated chmnic heart failure Cardiology, State Scienti$c-Clinical Centec Leninsk-Kuznetsky, Russian FederationThe purpose of this study was to investigate whether skeletal muscle electric stimulation could improve exercise performance in patients with decompensated chronic congestive heart failure (C...

LOZANO, L, ET AL.: Impact of Biventricular Pacing on Mortality in a Randomized Crossover Study of Pa tients with Heart Failure and Ventricular Arrhythmias. Biventricular (BV) pacing is under clinical in vestigation for the treatment of heart failure. Its impact on mortality is unknown. Patients with heart fail ure and ventricular tachyarrhythmias received an implantable cardioverter defibrillator with BV pacing capability. Patients were randomized 1:1 to BV pacing or no pacing, then crossed over to the alternate mode after 3 months. All-cause mortality was measured in each arm up to the point of crossover. Fifteen of 222 patients died between implant and crossover. Five patients died while programmed to BV pacing and 19 died while programmed to no pacing. Survival in the BV pacing arm was 93 ± 4% versus 86 ± 6% in the no pacing arm (P = 0.18). In a patient population with symptomatic heart failure and ventricular arrhythmias, BV pacing does not appear to be associated with excess mortality. Larger and longer studies will be needed to determine if BV pacing confers a survival benefit. (PACE 2000; 23[Pt. II]:1711-1712 biventricular pacing, mortality, heart failure, ventricular arrhythmias

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Objective-To determine whether implantable cardioverter-defibrillator (ICD) treatment is beneficial in elderly patients with life threatening ventricular tachyarrhythmias. Design-Since January 1984, ICDs were implanted in 450 patients to evaluate surgical risk, complications and mean survival in relation to patient age; 81 patients (18%) were < 50 years at the time of ICD implant, 254 patients (56%) were between 51 and 64 years, and the remaining 115 (26%) were > 65 years. Epicardial lead systems were implanted in 209 patients (46%), while transvenous lead systems were implanted in 241 (54%). Results-13 patients (3%) died perioperatively, more often after epicardial (11 of 209 patients, 5%) than after transvenous ICD implantation (one of 241 patients, < 1%) (p < 0.05). During a mean (SD) follow up of 28 (24) months (range < 1 to 114 months), 90 patients (20%) died. Of these, nine (2%) died from sudden arrhythmic death; five (1%) died suddenly, probably as a result of non-arrhythmic causes; 55 (12%) died from other cardiac causes (congestive heart failure, myocardial infarction); and 21 (5%) died from noncardiac causes. The three, five, and seven year survival for arrhythmic mortality was 95% in patients < 50 years compared with a three year survival of 93% and a five and seven year survival of 91% in patients of 51 to 64 years, and a three, five, and seven year survival of 99% in patients > 65 years. 362 patients (80%) received ICD discharges (21 (43) shocks per patient), with a similar incidence among all three patient groups (< 50 years, 80%; 51 to 64 years, 81%; > 65 years, 79%). The time interval between ICD implant and the first ICD treatment was shorter in patients > 65 years (8 (8) months) than in patients between 51 and 64 years (11 (14) months) or < 50 years (11 (11) months) (p < 0.05). Survival time following first appropriate shock was 30 (24) months in patients < 50 years, 30 (26) months in patients of 51 to 64 years, and 19 (20) months in patients > 65 years. Conclusions-Elderly patients benefit from ICD treatment, and survive for a considerable time after the first treatment. Therefore, elderly patients should be considered candidates for ICD implantation if life threatening ventricular tachyarrhythmias are present. (Heart 1997;78:364-370) Keywords: cardioverter-defibrillator; heart failure; sudden death; ICD discharges; elderly patients Sudden cardiac death is one of the major causes of mortality in western countries, with an incidence of 500 000 per year in the United States and 400 000 per year in Europe. Recent controlled clinical trials with antiarrhythmic drugs have raised serious questions about the long term eYcacy and benefit of pharmacological treatment for ventricular tachyarrhythmias.3 4 As a result, nonpharmacological alternatives have gained increasing acceptance in the treatment of such patients.5 6 Clinical experience to date suggests that cardioverter-defibrillator (ICD) treatment is an acceptable approach for preventing sudden cardiac death, and more than 50 000 patient...